gms | German Medical Science

Objectives: Although initially described in tuberculous arthritis, rice body formation in joints or bursae is a common phenomenon related to rheumatoid arthritis. It can be also observed in association with systemic lupus erythematosus, seronegative arthritis, infectious arthritis, non-specific arthritis and osteoarthritis. However, multiple rice bodies inside the tendon sheaths are usually seen in tuberculous tenosynovitis and rarely encountered among non-tuberculosis patients.

Method: Our study is based on 5 patients, 3 men and 2 women, aged between 35 and 70 years, with a disease evolution between 2 and 5 years. The women were known with rheumatoid arthritis, but no history of tuberculosis. All the 3 male patients had a clean medical history, with no diagnosed comorbidity. Trauma was not recorded in any of the patients. In 4 cases, the tenosynovitis included the flexor tendons in the forearm with only 1 case of extension in the palm, until the volar face of the first phalanx of 4th and 5th fingers. Paraclinical exams (ultrasounds and MRI) identified a heterogeneous mass without hemosiderin deposits and the distended structures contained a fluid collection and multiple tiny areas of low-signalintensity on T2-weighted and T1 isointensity with in the fluid. Pathological examination of the tissue obtained from the surgical intervention revealed synovial tissue with chronic synovitis and fibrinoid necrosis. Chronic inflammatory cells were present. Some tendon sheets contained amorphous eosinophilic material, as well as focal fibrinoid necrosis, which were interpreted asinitial changes of the process.

Results: Total recovery was observed following surgery and there has been no evidence of recurrence with6 months of follow-up.Due to destruction of deep flexor of the 5th finger, we performed a secondary surgical intervention at 3 months with the reconstruction of the affected flexor tendon.

Conclusion: Rice bodies are soft tissue collections of variable size which, macroscopically, resemble shiny white ricegrains and, microscopically, consist of an inner amorphous core of acidophilic material. They are a common finding in chronic diseases involving joints or bursae including many rheumatic diseases. For diagnosis orientation, MRI is the indicated exam. Rice bodies pathogenesis is uncertain. We should consider this diagnosis, even in patients whom are not diagnosed with any rheumatic disease or tuberculosis.